Development of OHS Strategy in Mental Health Condition

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Introduction

Common mental health circumstances in employees are not rare. Approximately about 20% of personnel fight mental health condition with a mainly high rate of these employees in the health sector. Indeed about one out of seven workers in British Columbia suffers from mental health condition. Mental health condition cause a deterioration in quality of life and work productivity and represents a vital economic strain to the society. The total costs associated indirectly and directly to mental healthy circumstances account for a greater proportion of the finances. The best practices are founded on an organized literature review, incorporation of stakeholders input, and seek to answer various questions. These questions include the aspect whether work-based interventions are effective in improving stay-at-work or return-to-work outcomes for employees suffering from mental health circumstances, what are the major aspects regarding efficient intervention, and specific intervention in regards to healthcare sector.

Although the significance of addressing work issues regarding employees with mental health conditions, the return-to-work practices are principally focused on employees with musculoskeletal injuries. Only lately has the devotion been paid to creating workplace-based intervention, which will facilitate stay-at-work and return-to-work for employees with mental health circumstances. For affected employees, common mental health circumstances were found to be more greatly linked with performance-related outcomes than to work absence. Because performance-related aspects goes handy with mental health conditions, gaining comprehensive data regarding mental health condition in the workplace is very complex.

These best practices are created with a motive of ensuring the safety of such workers. There are various aims that are associated with these best practices. Some of these include synthesize knowledge attained from quantitative evidence regarding which interventions are found effective in the improvement of stay-at-work or return-to-work outcomes in employees suffering from mental health conditions. The other aim of best practices is completing the knowledge with the evidence attained from the review and qualitative studies, and recognized reports and guidelines, in order to throw as wide a net as probable to capture the context that workplace-based intervention happens. The other aim includes documentation of the experiences of a broader array of stakeholders included in disability management comprising worker representatives.

There are various considerations that arise as a result of best practices implementation. These considerations include the aspect that best practices are not aimed to be a prescriptive device, but rather a reference point for implementation of objectives taking into concerns local context, interests, priorities, and capacities. The other consideration arising is that best practices evidence base comes from international settings, which differ in regards to culture, compensation systems, disability management policies, and healthcare services. These differences should be carefully considered in the implementation initiatives involved in the evidence base. The other consideration is that best practices are grounded from available evidence and imminent evidence can complement, overturn, or extend current suggestions.

During the development of best practices, there are various processes that should be adopted like the national Institute clinical and health excellence process that specifies standards and stages reading guideline development. The international Appraisal regarding guidelines for evaluation and research criteria provides a methodical framework for evaluating guideline quality, also steered the design of bets practices. Additionally, when considering qualitative studies that are mainly part of the systematic literature review, the best practices also taken to be a more comprehensive document set that includes narrative and systematic review, guidelines, qualitative studies, and reports. Moreover, stakeholder input and feedback are also necessary during the development, planning, and dissemination of best practices and made sure that best practices are relevant and applicable to stakeholder’s needs. However, best practices are grounded on best accessible evidence and stakeholders consensus, justifies the views and concerns of those who could be affected by the best practices, are advisory, relatively than prescriptive naturally.

The best practices conceptualization is steered by the integrated disability management framework that was stated by loisel and colleagues (2001). This framework was designed initially management of musculoskeletal injuries, but was currently reviewed as being significant to the mental health condition management. Permitting to this framework, disability is a multifactorial and rises from both environmental and individual factors. Individual factors are categorized as employee’s physical cognitive and affective characteristics, and the social network. Environmental characteristics are denoted to include workplace, compensation system, healthcare system, and interaction between all key stakeholders. The prevention of work disability as per this framework should be viewed as an integrated perspective other than a disease treatment perspective. Healthcare providers, workplaces, relevant stakeholders, and compensation system needs to be open to inter-professional communication and emphasize on facilitation of stay-at-work and return-to-work.

In comparison with musculoskeletal injuries, to this time, in the field of mental health conditions a lot of attention has been directed to interventions steered towards the individual only. However, the workplace has a vital role in the recovery of mental health circumstances. Stay-at-work or return-to-work practices must contemplate on a multitude of factors relating to both the environment and the worker included in the rehabilitation process. Extensive attention needs to be also paid to specifying significant shareholders, and to which aspects needs to be taken at which level in the stay-at-work or return-to-work and under what circumstances. Best practices aims at providing more specific evidence around these aspects.

Interventions that are explained in the best practices are structured around three levels including disability management practices, organizational, and individual-level interventions. The intervention in the organizational level is focused towards the entire organization to improve the psychosocial or physical environment within which the employee functions. The aim is to increase employee outcome by offering positive changes to the organization entirely. Instances of organizational-level intervention significant here are altering organizational policies, or developing people-oriented culture by supportive management practices. The intervention of disability management practice level is steered to practices of disability management and can either act to increase existing practices or introduction of new return-to-work practices. Instances of disability management intervention vital here is enlightening communication between return-to-work stakeholders or giving information to the employee regarding the return-to-work process. The individual level intervention looks on the individual employee and tries to increase access to care, worker care, or aid the worker better adjust to their environment. Instances of vital individual level intervention include occupational therapy, cognitive behavioral therapy, or care management.

There various interventions that are discussed above which are disability management practices, organizational, and individual-level have led to the development of five principles, which are necessary for the creation of the best practices strategies. In the organizational level intervention, the principle which emanates from this is a detailed, clear, well-communicated organizational office mental policy that supports the stay-at-work or return-to-work process. The other three strategies emanate from the disability management practice intervention where the second principle is return-to-work organization and planned, structured, close communication among workers, unions, employers, other disability management shareholders, and healthcare providers are expected to improve the stay-at-work or return-to-work. The third principle emanating from this intervention is the application of systematic, coordinated, and structured practices enhancing return-to-work outcomes. The fourth principle is work accommodations are an essential portion of the return-to-work process and the background regarding their implementation decides their effectiveness. The other principle emanates from the individual level intervention and it is the facilitation of access towards evidence-based treatment decreases work absence.

Before we discuss the principles, it is best to discuss the role associated with return-to-work coordinators, as their roles are closely related to many of the practices principles. The presentation of the five best practices is attained from the evidence synthesis. For every principle, we have to give the major points that give the main information regarding the complement and principle this information with the practice oriented strategies and actions. The principle-related strategies and actions may be undertaken by various stakeholders associated in the stay-at-work or return-to-work process. These stakeholders are union representatives, workers, employers, or healthcare providers. In the principles, we shall employ the use of return-to-work coordinators is mainly used and these coordinators have their role, which is mainly on coordination and management of the stay-at-work or return-to-work process.

As stated by Shaw, Hong, Pransky and Loisel (2008), the coordinators associated with the return-to-work process has various activities they need to do including development of plans in regards to work accommodation, assessment of workplace factors, facilitation of communication and agreements between stakeholders, provision of training and instruction to the workplace, and facilitation of access the healthcare treatments or providers. Shaw and colleagues (2008) also defined the core competencies that a return-to-work coordinator should possess including clinical interviewing, workplace mediation, workplace and ergonomic assessment, social problem solving, medical condition knowledge, and legal and business aspects knowledge. The return-to-work coordinators and the other major stakeholders, comprising the absent worker, are accountable for the execution of all the steps that should be taken for a fruitful stay-at-work and return-to-work process. Because the training of coordinators is not discipline-specific, their part is not openly mentioned when the parts of several stakeholders are given in the best practices principles.

In the organizational level intervention, the principle which emanates from this is a detailed, clear, well-communicated organizational office mental policy that supports the stay-at-work or return-to-work process. This principle is very vital in the development of mental health condition strategies. A detailed, clear, well-communicated organizational office mental policy is very vital as it helps reduce fragmentation, inaction and confusion regarding the stay-at-work or return-to-work of workers suffering from mental health circumstances. (Bilsker, Gilbert, Myette, & Stewart-Patterson, 2004; Caveen, Dewa, &Goering, 2006; Bergerman, Corabian & Harstall, 2009; Michalak, Yatham, Maxwell, Hale, & Lam, 2007; Mizzoni & Kirsh, 2006; National Institute for Health and Clinical Excellence [NICE], 2009b; Verdonk, de Rijk, Klinge, & de Vries, 2008; World Health Organization [WHO], 2005). Nurturing a people-oriented organizational culture by supportive management can help in the early identification, prevention, and management of mental health circumstances in the workplaces (Bilsker et al.

2004; Caveen et al., 2006; Saint-Arnaud, Saint-Jean, & Damasse, 2006).

Stigma about mental health conditions is a well indentified obstacle to the enactment of effective return-to-work creativities. Organizational investments in implementing and developing educational programs for staff regarding workplace mental healthcare can increase the visibility of and lessen the stigma regarding mental health conditions, aiding supervisors and co-workers in the timely identification of workers suffering from mental health circumstances and helping absent employees in returning to work (Bilsker et al., 2004; British Occupational Health Research Foundation [BOHRF], 2005; Caveen et al., 2006; Michalak et al., 2007; Mizzoni & Kirsh, 2006; Saint-Arnaud et al., 2006; WHO, 2005).

There are various strategies necessary for the attainment of this principle. Relevant stakeholders and employers need to look into developing a more supportive and open organizational climate and structure by implementing and developing a comprehensive and clear workplace mental health strategy in association with union representatives and workers. Such kind of policy comprises of five phases. The first phase is the creation of an organizational health profile. This involves establishing a coordinating body like a steering committee, or working team, to form an organizational health profile. This profile needs to aid the specific workplace stressors that impact employee’s mental health and identification of priorities for intervention. This health profile will aid in the development of a persuasive business case indicating the link between reduced productivity, poor mental health, and increased costs. This committee needs to include pertinent disability and medical providers, worker, employer, supervisor, and union representatives.

The other strategy that will help achieve this principle is development of the policy. This entails a visionary statement that presents a general image regarding the future associated with mental health in the working place and a comprehensive consultation needs to exist between working team and steering committee. When the visionary statement is attained, it is necessary to specify the principles and values in regards to people-centered human property practices and policies. Attainable organizational goals needs to be defined as a way of increasing awareness regarding mental health conditions and provision of intervention for work absent workers and affected workers. The other strategy is the development of strategies for implementation of the policy. The available resources and organizational needs will aid in guiding the strategies in regards to implementation regarding increasing awareness of mental health issues, organizational work change, supporting employees at risk, facilitation of access regarding appropriate evidence-based intervention for employees suffering from mental health circumstances in the workplace.

The other strategy is the implementation and dissemination of the policy. This through supporting and collaborating among employers, supervisors, workers, and union representatives are major in enhancing the implementation process. The established mandates and policies should be disseminated and well-communicated in the organization, either by company circulars, regular communiqués, posters, brochure, and newsletters. Good mandates reading benefit plans for mental health conditions needs to be available to employees. Workers and supervisors should be well trained so that they can well understand mental health conditions cases in the workplace. The last strategy is the development and implementation of an evaluation policy. Ideally, an evaluation needs to be planned if the policy is being designed as a way of assessing its effects to the organization and the workers. This can also be a milestone as it aid in the building of an evidence base regarding effective intervention of mental health in the workplace.

The other principle strategy for mental health condition emanating from the disability management practice intervention is the return-to-work organization and planned, structured, close communication among workers, unions, employers, other disability management shareholders, and healthcare providers are expected to improve the stay-at-work or return-to-work… The negotiation between stakeholders and the coordinators of the return-to-work are expected to achieve individualized strategies reading the return-to-work. For a successful attainment of these strategies, a return-to-work coordinator needs to coordinate the process well. (BOHRF, 2005; Caveen et al., 2006; Corbière & Shen, 2006; NICE, 2009b; vander Klink et al., 2007; Rebergen, Bruinvels, Bezemer, van der Beek, & van Mechelen, 2009; Rebergen, Bruinvels, van Tulder, vander Beek, & van Mechelen, 2009; Steffick, Fortney, Smith, & Pyne, 2006; Verdonk et al.; Wald & Alvaro, 2004).

Telephone or person contacts can lead to an earlier return-to-work or bigger rates regarding return-to-work (Dewa, Hoch, Carmen, Guscott, & Anderson, 2009; Rebergen, Bruinvels, Bezemer, et al., 2009) and could also be cost-effective modes of planned and structured communication among the supervisor, worker, union representatives, and healthcare providers. The aspect of maintaining connection among the workplace and absent worker by use of appropriate communication has a positive effect towards the employee’s return-to-work experience (BOHRF, 2005; Corbière & Shen, 2006; NICE, 2009b). The use of disability management involves silos of individuals having a stake in employees’ healthcare, successful return to job, and administration regarding disability benefits. Close, structured communication enhances that coordinators of return-to-work, independent healthcare providers, and the representatives of unions establish a link with each other, maintaining their focus regarding the outcomes of the return-to-work process, have a common objective, and include the employee in the formulation of the return-to-work strategy. Individualized return-t-work plans and strategies are advantageous in the reintegration of the employee in the workplace. These plans are effective if they are designed collaboratively with the return-to-work coordinators, healthcare providers, union councils, and the employee.

The other principle emanating from the disability management practice intervention is the application of systematic, coordinated, and structured practices enhancing return-to-work outcomes. There are various guidelines that are well used as a way of decreasing the time and full and partial return-to-work rates (Corbière & Shen, 2006; Rebergen, Bruinvels, Bezemer, et al., 2009; Rebergen, Bruinvels, van Tulder, et al., 2009). The practices of return-to-work, which activates the employee and aid keep the employee occupied in the process of return-to-work are efficient in adding the partial return-to-work time and return-to-work rates (Corbière & Shen, 2006; van der Klink et al., 2007; Rebergen, Bruinvels, Bezemer, et al., 2009; Rebergen, Bruinvels, van Tulder, et al., 2009). The practices of return-to-work which are goal-oriented, specific, and notable, basically focus on workplace behavior, work function, and the outcomes of the return-to-work. Check-ins at different times, to evaluate the progress of the worker’s needs and the process of return-to-work are vital practices regarding the return-to-work (Corbière & Shen, 2006; Dewa et al., 2009; Grossi & Santell, 2009; Heidel et al., 2007; Lander, Friche, Tornemand, Andersen, & Kirkesokov, 2009; NICE, 2009b; Nieuwenhuijsen et al., 2008; Rebergen, Bruinvels, Bezemer, et al., 2009; Saint-Arnaud et al., 2006; Søgaard & Bech, 2009; van der Klink et al., 2007; van Oostrom et al., 2009; Wang et. al., 2007). They may include relapse prevention, follow-up check-in, initial intake, continuous check-in in intervention, and detailed evaluation with potential transfers to specialists for further assessment.

The other principle emanating from the disability management practice intervention is the work accommodations are an essential portion of the return-to-work process and the background regarding their implementation decides their effectiveness. Work accommodation being part of the process of return-to-work are recommended. However, the requirement regarding appropriate work accommodation and how they will be implemented needs to take into consideration the circumstance surrounding the workplace and the worker (Krupa, 2007; Mizzoni & Kirsh, 2006; NICE, 2009b; van der Klink et al., 2007).Despite the fact that work accommodations are very beneficial to employees and workplaces, they could also design unforeseen obstacles regarding the return-to-work process, if it is unsuitably implemented or conceived. Due to this reason, moderate evidence supports various considerations regarding the implementation of work accommodations. Work accommodation needs to involve a sensible reduction or redistribution of work demands regarding co-workers and worker (Krupa, 2007; Saint-Arnaud et al., 2006).

This is also achieved through transitions. Making transitions to lower stressful environment could be advantageous for work absent employees who are not able to cope or change with the fast paced, big-pressure nature regarding working conditions (Mizzoni & Kirsh, 2006; Saint-Arnaud et al., 2006; Verdonk, et al., 2008). Senior management maintenance of work accommodation has a notable impact to the rates of return-to-work for employees suffering from mental health circumstances who are not present in work (Caveen, et al., 2006; Mizzoni & Kirsh, 2006). Support from co-workers is very vital for the achievement of work accommodation, but co-worker’s uncertain knowledge regarding worker’s limitation and strength and stigma can affect that success (Krupa, 2007; Michalak et al, 2007; Mizzoni & Kirsh, 2006; Saint-Arnaud et al., 2006).

The other principle emanates from the individual level intervention and it is the facilitation of access towards evidence-based treatment decreases work absence. The delivery by properly occupational physicians regarding activation intervention based on the therapy of cognitive behavioral principles ends in improved full and partial return-to-work rates and reduces the return-to-work time between employees with common mental health circumstances (BOHRF, 2005; Corbière & Shen, 2006; van der Klink et al., 2007; Rebergen, Bruinvels, Bezemer, et al., 2009; Rebergen, Bruinvels, van Tulder, et al., 2009).The delivery by use of insurer-based skilled mental health profession regarding cognitive behavioral treatment-based care and rates of depressive symptoms (van Oostrom et al., 2009; Wang et al., 2007). To decrease the work absence time, increase the rate of partial return-to-work and reduce symptoms, cognitive behavioral treatment-based interventions needs to be linked with the subsequent work-focused interventions (Bilsker et al., 2004; NICE, 2009b; van der Klink et al., 2007; Rebergen, Bruinvels, Bezemer, et al., 2009; Rebergen, Bruinvels, van Tulder, et al., 2009; van Oostrom et al., 2009) and they are counseling regarding the return to work, and the work accommodations.

Conclusion

The use of mental health prevention and treatment is an aspect that is very important to reduce these instances. This is an aspect that better strategies need to be put in place so that workers can get back to work and serve the others. Mental health condition check-ups would help make it a better aspect of reducing this aspect of such conditions. The application of the five principles, which are detailed, clear, well-communicated organizational office mental policy that supports the stay-at-work or return-to-work process, return-to-work organization and planned, structured, close communication among workers, unions, employers, other disability management shareholders, and healthcare providers are expected to improve the stay-at-work or return-to-work, application of systematic, coordinated, and structured practices enhancing return-to-work outcomes, work accommodations are an essential portion of the return-to-work process and the background regarding their implementation decides their effectiveness, and the facilitation of access towards evidence-based treatment decreases work absence are very instrumental in the aspect of stay-at-work and return-to-work process. These strategies should be effectively implemented and designed to aid in elimination of these conditions.

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